Metro to get $5.5M for Shared Savings work

MetroHealth accomplished what none of its peers in Northeast Ohio could do — and it'll get a nice check for doing so.

This year, the health system has the only accountable care organization in the region that will receive a payout from the federal government for helping save money in their care for seniors in 2017.

MetroHealth will receive a payout of nearly $5.5 million for its performance in the Medicare Shared Savings Program, which is one of the most well-known of the accountable care organization (ACO) programs designed to reward organizations that provide high-quality, coordinated care at a controlled cost. It's far different from the traditional reimbursement models across most health care programs that simply pay out based on how many services are rendered.

It's a complex formula, but the Centers for Medicare and Medicaid Services establishes a spending benchmark for each participating ACO. For a health system to get a slice of the savings, they have to spend less than that threshold by at least a certain percentage, which is also established by CMS.

Cleveland Clinic's ACO and University Hospitals' ACO both spent above their established benchmark by $19.7 million and $27.4 million, respectively. Summa Health's ACO, NewHealth Collaborative, saved money — $2.2 million — but not enough to crack the threshold to achieve shared savings from the federal government.

MetroHealth's ACO, MetroHealth Care Partners, saved money in the program at a rate of 10.2%, far above the established threshold of 2%, catapulting the system to the 18th-highest savings rate in the country, among the 472 participating ACOs, and the highest in the state. This is a significant improvement upon the system's start in the program. MetroHealth overspent in its first year of participation (2014), saved under the benchmark in its second year and then achieved savings in its third and fourth years.

"It's really putting a program around quality and efficiency for this patient population," said Dr. Nabil Chehade, senior vice president of population health and chair of the MetroHealth Care Partners ACO governing board. "MetroHealth has been on this journey ... but as you can see, it doesn't take effect immediately with the results and the outcomes, because it takes a lot of time to do this, to put the building blocks."

While MetroHealth has been able to improve its performance year over year, Summa, which achieved shared savings in the first three years it participated in the program, has been unable to pass that target in the past two years. It saved the government money in both 2016 and 2017, but not enough to trigger savings. Summa's interim president and CEO, Dr. Cliff Deveny, attributed this, in part, to the fact that the savings threshold is based on systems' historical performance in the program. So as systems show they can save money, that bar becomes more difficult to pass.

Mark E. Schario, vice president of population health at UH, also pointed to the lowering benchmark as the predominant reason the system's ACO, University Hospitals Coordinated Care Organization, was unable to achieve shared savings.

Deveny also noted that Summa's participation in other programs in which the government gives the system money to care for populations actually works against them, elevating the amount of money spent, even though those dollars came from other value-based incentive programs.

Cleveland Clinic pointed to this phenomenon as well, noting that the system in 2017 enrolled in a different Medicare program called the Comprehensive Primary Care Plus.

Dr. Nirav Vakharia, associate chief quality officer and vice chair of population management at Cleveland Clinic, said the upfront funding from that program was close to the amount of money the system overspent for the shared savings program. He also pointed to some increased utilization rates in 2017 as a reason the system didn't save money.

"We feel confident that our clinical model that we are putting in place is really patient-centered," Vakharia said. "And you know, if patients need to go into the hospital for their health condition, so be it. We are happy to make sure that they get the best care they can at the best site they can."

For care provided in 2016, the Clinic received a shared savings payout of $19.9 million. MetroHealth received a $4.3 million share of generated savings. University Hospitals overspent in 2016, and Summa didn't save enough to trigger shared savings.

The Medicare Shared Savings Program also awards a quality score to participating ACOs. Summa's ACO quality score was 90.4%, the same as the year before.

MetroHealth's ACO quality score was 87%, the Clinic's was 85.5%, and UH's was 73.4% — all of which were a drop from the year prior. Officials, in part, attributed this to the fact that at first, points were simply awarded for reporting metrics, but over time, the process shifts to points being awarded based on the metrics themselves. This makes the numbers not an apples-to-apples comparison.

"That number is lower than it was last year, and we're actively working with our physician providers and our network to make improvements in that," Schario said. "It's a nationally reported number. Yes, things changed. You can see there's quality drops for a lot of organizations."

MetroHealth this year participated in the program on a different model in which it accepted a downside risk, meaning if the system overspent, it would have to pay money to the government. The benefit, though, is that the system can get back up to 75% of the savings, Chehade said.

The other local ACOs operated on a one-sided risk model in which they don't risk having to pay out money if they don't achieve savings, but if they do, they can get back up to 50%.

ACOs participate in the program for three-year stints. The Clinic has re-enrolled to participate in the model with a downside risk.

"I think a lot of the national data is showing that performance improves when health systems take on the downside risk," Vakharia said. "We still believe it's absolutely the right thing to do and demonstrates that this is our commitment as a leading health care provider in Northeast Ohio. ... We are willing to accept that responsibility and that accountability because this is the direction that health care has to go if we're going to control spending while keeping the health of the population as good as it can be in the long run."